Renal

Question 1

what endocrine work do the kidneys do?

Answer 1

produce erythropoietin
activates vitamin D
controls blood pressure via RAAS

Question 2

what are some renal investigations that can be done by looking at the urine?

Answer 2

dipsticks - glucose/blood/protein/WBC’s
microscopy
microbiology

Question 3

what are some renal investigations that can be done by looking at the blood?

Answer 3

electrolytes
glomerular filtrate rate
specific tests

Question 4

what imaging tests can be done for renal?

Answer 4

plain xrays
intravenous urogram
ultrasound
MRI
CT

Question 5

what investigations can be done via looking at the tissue?

Answer 5

renal biopsy

Question 6

what are some consequences of renal failure?

Answer 6

oedema
high potassium - cardiac arrest
accumulation of waste products - ureamia 
drug metabolism
acidosis
lack of erythropoietin
lack of vit d 
high bp

Question 7

what are some causes of renal failure?

Answer 7

diabetes
high bp
artherosclerosis
autoimmune - glomerulonephritis
cancer - myeloma
hypovolaemia

Question 8

what drugs can cause renal failure by exacerbating pre existing disease?

Answer 8

NSAIDS
ACE inhibitors
diuretics
tetracyclines
idiosyncratic reactions - penicillin/NSAIDS

Question 9

what infections can cause renal failure

Answer 9

recurrent ascending UTI’s

Question 10

what kind of obstructions can cause renal failure?

Answer 10

prostate
stones
abdominal/pelvic stones
polycystic kidney disease

Question 11

what are the 2 forms of renal disease?

Answer 11

acute

chronic

Question 12

what is acute renal failure?

Answer 12

• acute loss of renal function - normal/low absent urine -output
• life threatning - hyperkaleamia/uraemia, fluid retention, hypertension

Question 13

is acute renal failure reversible?

Answer 13

often, yes

Question 14

does acute failure happen in healthy kidneys?

Answer 14

usually pre existing disease

Question 15

how to manage acute failure?

Answer 15

manage underlying cause
treat effects - potassium/fluid removal or replacement
dialysis?

Question 16

what is chronic renal failure?

Answer 16

gradual progression of renal impairment
end stage renal disease where GFR is 5% of norm
progression depends on underlying cause and modifying factors

Question 17

what are the most common causes of chronic renal failure?

Answer 17

diabetic retinopathy
glomerulonephritis
chronic renal infection
polscytic renal disease
atherosclerosis
high bp

Question 18

what are the effects of chronic renal disease?

Answer 18

uraemia - reduced immunity/platelet function/malaise/nausea/itch
fluid retention - hypertension/odeama
lack of erythropoietin - anaemmia
renal osteodystrophy - secondary hyperparathyroidism

Question 19

how to treat chronic renal failure?

Answer 19

avoid further damage - control hypertension/diabetes, immunosuppresion, avoid/reduce drugs, treat any obstructions

• correct anaemia - erythropoietin injections
• correct vit d deficiency

Question 20

types of dialysis?

Answer 20

haemodyalasis

peritoneal dialysis

Question 21

what are some problems that may rise from transplant?

Answer 21

rejection - acute/chronic
immunosuppresion - increased infection/malignancy risk
high cardiovascular mortality

Question 22

what is a UTI?

Answer 22

cystitis
increased risk if impaired bladder emptying or low urinary flow rates
e.coli gram negative bacilli

Question 23

symptoms of UTI and management?

Answer 23

dysurua
pain
antibiotics/increased fluid intake

Question 24

what may cause a urinary tract obstruction?

Answer 24

prostate
renal calculi
external compression - abdonminal/pelvic malignancies

Question 25

what oral problems may renal osteodyrstrophy cause?

Answer 25

loss of lamina dura radiolucencies problems with bone healing post extraction

Question 26

why may renal patients have greater bleeding tendencies?

Answer 26

abnormal platelet production, diminished factor 3 and von wilebrands factor

Question 27

when should you treat a dialysis patient in the dentist and why?

Answer 27

day after dialysis once heparin worn off

Question 28

what patients may require pep before an invasive procedure?

Answer 28

``` polycystic kidneys peritoneal dialysis some on haemodialysis renal transplant discuss with renal team ```

Question 29

what orofacial manifestations may be seen in renal patients?

Answer 29

osseus lesions - loss of LD, osteoporosis, osteolytic areas, secondary hyperparathyroidism = giant cell lesion, abnormal bone repair

Question 30

what oral signs may a chronic renal failure patient experience?

Answer 30

dry mouth, halitosis, metallic taste insidious oral bleeding/purpura, salivary gland swelling calculus accumulations, oral ulceration and changes b/c anaemia

Question 31

chronic renal failure in children may cause what orally?

Answer 31

``` jaw growth retarded tooth eruption delayed malocclusion brownish tooth discolouration prev tetracycline staining low caries rate/less perio disease ```